Maryland women want better menopause care. Lawmakers are listening.

The Maryland Commission for Women was looking for ways to elevate menopause care in the state. Turns out all they had to do was ask.

Women from across Maryland responded on social media, telling stories of life-altering symptoms — hot flashes, poor sleep, brain fog, vaginal dryness, painful sex, mood changes, weight gain — and their frustrations with a medical system failing them.

A Frederick County woman recalled that her doctor told her, “That is just how it is.”

“It shouldn’t be this difficult to receive care for something that 50% of the population will eventually experience,” said a 56-year-old from Prince George’s County.

“I had to find out about HRT from a YouTube influencer,” another woman wrote, referring to hormone replacement therapy.

The commission heard their cries and backed legislation championed by top female lawmakers aiming to expand providers’ clinical training when it comes to identifying and treating menopause and perimenopause. The bill also requires health insurance companies to cover evaluations and care, something many were already doing.

“We need to get involved because there’s a need, and it hasn’t addressed itself organically,” said Commission Executive Director Ariana Kelly. The commission has a legal mandate to study and address the needs of Maryland women.

The bill, co-sponsored by House Speaker Joseline Peña-Melnyk and Sen. Dawn Gile, both Democrats, puts Maryland in a league with a growing number of states enacting menopause-related protections and a national movement to encourage an oft-avoided conversation.

“I am not afraid to discuss menopause as a public health issue and to bring to this conversation the enormity of the challenges that we women of a certain age experience with hormonal changes in our bodies — and how frustrating it is that the health care system still treats us like a mystery," Peña-Melnyk, who represents parts of Anne Arundel and Prince George’s counties, said in a statement.

Celebrities such as media mogul Oprah Winfrey and actor Halle Berry have shared their own menopause journeys. Social media influencers and nationally recognized medical experts are satisfying a growing hunger for information online, flooding Instagram and TikTok feeds with a mixture of sympathy and advice.

Medical experts say patients approaching them in recent years have forced practitioners to seek training they may not have gotten in medical school.

Further fueling demand: The Trump administration in November lifted a decades-old Food and Drug Administration warning for hormone replacement based on highly criticized medical research.

Menopausal-aged women are also pushing through these symptoms during the peak of their careers, making it an economic issue as well as a political one. A 2023 Mayo Clinic study extrapolated $1.8 billion in costs from lost productivity because of menopause symptoms.

Years of navigating her own menopause mystery convinced one industry leader to elevate the conversation around menopause in the workplace.

Tisha Edwards, the president and CEO of the Maryland Bankers Association, who has also worked for Gov. Wes Moore and Baltimore City, said education is key to ensuring that women can thrive.

“People cringe when you say the word menopause, right? It has a doomsday, icky kind of undertone to it, and we’ve got to bring light to it,” Edwards said.

The average age for menopause is around 51 1/2 and officially starts when a woman has missed her period for 12 consecutive months.

It’s precursor, perimenopause, occurs when the body’s production of estrogen and progesterone starts waning. A woman’s periods may become irregular, closer together and heavier. Symptoms, such as hot flashes and brain fog, can happen during both phases.

But there’s good news. Treatment exists, and women don’t have to wait until full-on menopause to get it, said Dr. Ishrat Rafi, a board-certified obstetrician and gynecologist and Maryland’s district chair for the American College of Obstetricians and Gynecology.

Rafi acknowledged that a doctor’s understanding of menopausal patients largely depends on their training. She benefited from training with a menopause specialist roughly 30 years ago.

Demand for treatment plummeted in the early 2000s, Rafi recalled, after a flawed study — and subsequent misinformation about breast cancer, stroke and blot clot risks — scared women.

“Overnight, women stopped taking their hormones,” Rafi said, during what she called “the dark years.”

Rafi urged women to talk to their doctors about the range of possible treatments and potential risks related to their own health histories.

“It’s all about your symptoms, and if your provider is trained properly, they should be able to help you,” said Sarah Kurtz, lead midwife at the Baltimore Washington Medical Center. Kurtz spoke in support of the legislation that would double continuing education credits for practitioners like her who take a menopause training.

Kurtz said preliminary research shows that taking hormones may protect against bone loss and dementia and considers treatment now a benefit to her patients’ future health.

“I’m also worried about you 10, 15, 20 years down the road and giving you a good quality of life,” she said.

Edwards, 55, thinks perimenopause started showing up for her in her mid-late 40s and has read that symptoms can appear earlier, last longer and present differently for Black women.

“I think that’s what really angers me about this, is that I started going through a significant health journey and had no vocabulary for it,” she said.

She first noticed heightened anxiety, low energy, poor sleep and dry, itchy skin. Then there were the cognitive challenges. She felt unfocused at work and was forgetting names. She wondered if she was experiencing dementia.

“I’m in my mid- to late 40s, and I’m talking about things, but the doctor isn’t saying: ‘Have you considered [menopause]?’” she recalled.

Eventually, her gynecologist prescribed hormones to supplement what her body was no longer producing. This helped her feel more stable as she made key lifestyle changes to her diet and exercise.

Edwards said she’ll continue to call for the normalization of women’s menopause experiences.

“It is a part of a health journey,” she said. “But it is also an opportunity for women to reclaim their independence.”